Treatment of diverticular disease: an update on latest evidence and clinical implications

Abstract

BackgroundDiverticular disease (DD) is a common condition, especially in Western countries. In about 80% of patients, colonic diverticula remain asymptomatic (diverticulosis), while approximately 20% of patients may develop abdominal symptoms (symptomatic uncomplicated diverticular disease, SUDD) and, eventually complications as acute diverticulitis (AD). The management of this condition has been improved, and in the last five years European countries and the USA have published guidelines and recommendations.ScopeTo summarize the latest evidence and clinical implication in treatment of DD focusing the attention either on the treatment of diverticulosis, SUDD and AD together with the primary and secondary prevention of diverticulitis.FindingsThe present review was based on the latest evidence in the treatment of DD in the last 10 years. In the last 5 years, six countries issued guidelines on DD with differences regarding covered topics and recommendations regarding treatments. At present there is a lack of rationale for drug use in patients with asymptomatic diverticulosis, but there are limited indications to suggest an increase in dietary fibre to reduce risk of DD. To achieve symptomatic relief in SUDD patients, several therapeutic strategies with fibre, probiotics, rifaximin and mesalazine have been proposed even if a standard therapeutic approach remained to be defined. Agreement has been reached for the management of AD, since recent guidelines showed that antibiotics can be used selectively, rather than routinely in uncomplicated AD, although use of antibiotics remained crucial in the management of complicated cases. With regard to treatment for the primary and secondary prevention of AD, the efficacy of rifaximin and mesalazine has been proposed although with discordant recommendations among guidelines.ConclusionTreatment of DD represented an important challenge in clinical practice, especially concerning management of SUDD and the primary and secondary prevention of AD.

Computational analysis of mechanical stress in colonic diverticulosis

“…Moreover, our simulations show that a significant luminal pressure drop (between 40% and 56% for the simulated cases) would be necessary to restore stress back to a normal level. This would explain the low effectiveness of a high-fiber diet as a stand-alone treatment solution once pouches are developed [20][21][22] since it may not be enough to achieve the required pressure drop to reduce stress in the tissue and prevent pouch progression.…”

The management of diverticulitis: a review of the guidelines

“…Uncomplicated diverticulitis has historically been managed with antibiotic therapy, but most international guidelines now recommend a clear liquid diet, and antibiotic use on a selective case‐by‐case basis only. Although the use of antibiotics in outpatient management of diverticulitis remains the norm in the United States, a recent review notes that there is insufficient evidence to defend routine antibiotic use in this setting .…”

“…Several reviews make conditional recommendations for a range of protective factors that may prevent the development of diverticular disease and some of its sequelae. However, only some general lifestyle recommendations (eg, body mass index < 30, vigorous exercise, avoiding smoking, and limiting red meat consumption) are backed by sufficient evidence showing reduction in the incidence of diverticular disease (Box 3).…”

Diverticuloza colonică la pacientul ambulator

“…În cazul bolii diverticulare, episoadele dureroase sunt mai rare, dar cu durată mai lungă, de obicei cu localizare în etajul abdominal inferior, tind să fie de intensitate mai mare, cu caracter colicativ, nu se ameliorează cu pasajul gazelor sau al materiilor fecale şi se asociază frecvent cu diaree cronică. Precipitarea crizelor dureroase după ingestia de alimente este uneori relatată de pacienţi (7)(8)(9)(10)(11).…”

“…Pentru cei cu colon iritabil, durerea este mai generalizată, episoadele sunt cu frecvenţă mai mare, de intensitate şi durată mai mică, acuză tenesme rectale, iar în timpul durerii pot prezenta debutul diareei sau al constipaţiei (8)(9)(10). În literatura de specialitate sunt raportate asocieri între cele două patologii.…”